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Tue Jul 24 01:44:55 BST 2007

One of the articles - a mathematical model of bleeding and replacement therapy.Ivan

> Date: Mon, 23 Jul 2007 22:22:53 +0000> From: atacc.doc at btinternet.com> To: trauma-list at trauma.org> Subject: Re: Massive Transfusion Protocol: What's in YOUR pack?> > Hi Karim,> Publications regularly quoted in conference:> -Can J Surg: Dec 2005> -J trauma suppl: June:2006> -J Trauma: Jan 2007> -Surg Commander Holcomb: prelim reports of a definitive 2007 paper out of Iraq, which has gone to press I am told (BTS representative)> > Cheers> Mark F> > > ----- Original Message ----> From: Karim Brohi <karimbrohi at gmail.com>> To: "Trauma &, Critical Care mailing list" <trauma-list at trauma.org>> Sent: Monday, 23 July, 2007 6:18:31 PM> Subject: Re: Massive Transfusion Protocol: What's in YOUR pack?> > > OK. For those of you who have decided to use 1:1 FFP:RBCs, what evidence> (published) are you basing this on?> > Karim> > > On 23/07/07, Andrew J Bowman <andrewj.bowman at gmail.com> wrote:> >> > We did not even have them as guidelines.> >> > Andrew> >> >> > On 7/23/07, Hardcastle, Tim, Dr <tch at sun.ac.za> <tch at sun.ac.za> wrote:> > >> > > No> > >> > > Actually working in countries where "clinical judgement" is still the> > > prime reason for making decisions rather than following a written set of> > > rules. While protocols may be helpful they are not the gold-standard of> > care> > > by any means. At best they should be a guideline - deviated from by any> > > worthy clinician with same judgement.> > >> > > Tim> > > Dr T C Hardcastle> > > M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)> > > Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)> > > ATLS instructor and DSTC Cape Town Course Director> > > Intern program Coordinator: Surgery> > > M.Med (Emergency Medicine) Executive Committee member> > > Clinical Head (Director): Diana Princess of Wales Trauma Unit> > > Division of Surgery (General) Room 4064> > > Department of Surgical Sciences> > > Tygerberg Hospital / University of Stellenbosch> > > PO Box 19063> > > Tygerberg 7505> > > Western Cape> > > South Africa> > > e-mail: tch at sun.ac.za> > > Cell: +27824681615> > > Office: +27219389281 or 4911 pager 0302> > >> > >> > >> > > -----Original Message-----> > > From: trauma-list-bounces at trauma.org> > > [mailto:trauma-list-bounces at trauma.org]On Behalf Of Andrew J Bowman> > > Sent: Monday, July 23, 2007 6:47 AM> > > To: Trauma &amp, Critical Care mailing list> > > Subject: Re: Massive Transfusion Protocol: What's in YOUR pack?> > >> > >> > > Complacency and lack of trauma foresight. (at least where I have worked> > in> > > the past)> > >> > > Andrew> > >> > >> > > On 7/23/07, Errington Thompson <errington at erringtonthompson.com> wrote:> > > >> > > > Is there a reason NOT to have a massive transfusion protocol?> > > >> > > > E> > > >> > > > Errington C. Thompson, MD, FACS, FCCM> > > > Trauma/Surgical Critical Care> > > > Author - Letter to America> > > > Asheville, NC> > > >> > > > -----Original Message-----> > > > From: trauma-list-bounces at trauma.org [mailto:> > > > trauma-list-bounces at trauma.org]> > > > On Behalf Of MARK FORREST> > > > Sent: Sunday, July 22, 2007 7:16 PM> > > > To: Trauma &amp; Critical Care mailing list> > > > Subject: Re: Massive Transfusion Protocol: What's in YOUR pack?> > > >> > > > Hi Karim,> > > > The hospital protocol is actually lagging behing the labs own practice> > > and> > > > they are supporting the new practices of the theatre teams:> > > >> > > > A:> > > > 1- After fourth unit of blood we start requesting 1:1 FFP:Blood> > > >> > > > B> > > > After 6 unit transfusion we now assume that you are already working on> > > an> > > > established coagulopathy, especially if they are hypothermic> > > >> > > > After 6 units, request 2 FFP if we are employing permissive anaemia> > > > (target> > > > 7-8 g/dl). If higher Hb level and haemostasis has been clinically> > > achieved> > > > then may give none at this late stage.> > > >> > > > NO Factor VIIa if they have a temp less than 35 degree becasue of its> > > > dramatcally reduced function.> > > >> > > > C> > > > Lab clotting result will realistically take about 30 mins to 1 hour,> > > which> > > > is obviously useless if still bleeding or operating.> > > >> > > > We have no reliable NPT and we do not currently have a TEG as our> > > > transfusion team believe that it is not a reliable measure> > > >> > > > Cheers> > > > Mark F> > > > UK> > > >> > > >> > > > ----- Original Message ----> > > > From: Karim Brohi <karim at trauma.org>> > > > To: Trauma & Critical Care mailing list <trauma-list at trauma.org>> > > > Sent: Sunday, 22 July, 2007 10:37:24 PM> > > > Subject: Massive Transfusion Protocol: What's in YOUR pack?> > > >> > > >> > > > Dear All,> > > >> > > > A straw poll if you don't mind on massive transfusion protocols for> > > > traumatic haemorrhage. Please base your answers on your current> > > practice> > > > or> > > > your institution's current practice, not latest research / hearsay> > etc:> > > >> > > > A. If you HAVE a massive transfusion protocol in your hospital:> > > >> > > > 1. Are you given packs of FFP according to how many units of blood> > > > have been administered?> > > > (eg. 2 units of FFP after every 6 units of blood)> > > >> > > > 2. How much FFP after how much blood?> > > >> > > > 3. If your answer to (1) was NO, what's the make-up of your packs> > > >> > > > B. If you have just administered 6 units of blood:> > > >> > > > 1. Do you always give a certain amount of FFP or do you wait for> > > > labs? Which labs?> > > >> > > > 2. If you give FFP, how much for those 6 units would you consider> > > > standard?> > > >> > > > 3. What is the minimum that should be given (0 is an acceptable> > > > answer)> > > >> > > > C. Labs:> > > >> > > > 1. You send a PT/PTT from the ED or Operating room. How soon do> > you> > > > get it back? (really)> > > >> > > > 2. Do you have point of care testing for PT/PTT in the ED & OR?> > > >> > > > 3. Do you do thromboelastometry routinely on bleeding trauma> > > > patients in the ED and OR?> > > >> > > > There are no right or wrong answers, as practice varies so> > widely. I'm> > > > just> > > > trying to see the breadth of responses. So as many replies as possible> > > > please - even from the lurkers :-)> > > >> > > > Karim> > > >> > > > --> > > > trauma-list : TRAUMA.ORG> > > > To change your settings or unsubscribe visit:> > > > http://www.trauma.org/index.php?/community/> > > > --> > > > trauma-list : TRAUMA.ORG> > > > To change your settings or unsubscribe visit:> > > > http://www.trauma.org/index.php?/community/> > > >> > > > --> > > > trauma-list : TRAUMA.ORG> > > > To change your settings or unsubscribe visit:> > > > http://www.trauma.org/index.php?/community/> > > >> > > --> > > trauma-list : TRAUMA.ORG> > > To change your settings or unsubscribe visit:> > > http://www.trauma.org/index.php?/community/> > > --> > > trauma-list : TRAUMA.ORG> > > To change your settings or unsubscribe visit:> > > http://www.trauma.org/index.php?/community/> > >> > --> > trauma-list : TRAUMA.ORG> > To change your settings or unsubscribe visit:> > http://www.trauma.org/index.php?/community/> >> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/
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Massive Transfusion Protocol: What's in YOUR pack?